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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-304022
  • Cognition
  • Review

HIV, dementia and antiretroviral drugs: 30 years of an epidemic

  1. Alan Winston4,5
  1. 1MRC Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, USA
  2. 2Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, USA
  3. 3Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, UK
  4. 4Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
  5. 5Department of HIV and GU Medicine, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Hadi Manji, MRC Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; hadi.Manji{at}uclh.nhs.uk
  • Received 24 August 2012
  • Accepted 7 January 2013
  • Published Online First 1 February 2013

Abstract

Neurological complications due to the HIV itself became apparent early on in the course of the AIDS epidemic. The most feared were the cognitive and motor complications termed AIDS dementia complex or HIV-associated dementia. With the introduction of combination antiretroviral therapy, the incidence of HIV-associated dementia has been dramatically reduced. However, the prevalence of less severe forms of the disorder remains around 20%. There is controversy about whether some patients may continue with progressive cognitive decline despite adequate suppression of the HIV. The salient issues are those of cerebrospinal fluid (CSF) drug penetration, drug neurotoxicity and persistent immune activation and inflammation. This review will also discuss other newly encountered complications, including the compartmentalisation (or CSF escape) and immune reconstitution inflammatory syndromes.

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